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Pharmacology > Chemotherapy, Immunosuppressive, and Hematology Drugs > Flashcards

Chemotherapy, Immunosuppressive, and Hematology Drugs Flashcards

1
Q

Alkylating Agents: Nitrogen Mustards

A

MOA
- causes abnormal base pairing, misreading of the genetic code, and excision of bases = prevents DNA replication and RNA transcription = cell death

But also toxic to most rapidly growing normal cells –> bone marrow, GI epithelial cells, hair
Why see ADR = vomiting, diarrhea, ulcers, alopecia

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2
Q

Cyclophosphamide (Procytox)

A

Alkylating Agent
For carcinomas, sarcomas, feline lymphoproliferative diseases, mammary carcinoma and lymphoma

It’s a prodrug = hepatic metabolism forms active metabolites = hydroxyphosphamide and aldophosphamide

ADR

  • dose-dependent bone marrow toxicity = leukopenia, neutropenia, thrombocytopenia
  • GI: vomiting, diarrhea
  • Hemorrhagic cystitis (look likes a UTI but it’s sterile)
  • Alopecia
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3
Q

Chlorambucil -> Leukeran

A

Alkylating Agent
Similar to cyclophosphamide but less potent and less toxic
Expensive
Immunosuppressive drug of choice for cats after prednisone

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4
Q

Nitrosoureas: The ‘mustine/CNU’ drugs

A

Also alkylate the DNA
Lipid-soluble -> very good oral bioavailability
- since enters cells passively = no efflux pump resistance

For lymphomas, mast cell tumors, anecdotally for brain tumors

Leukopenia and can cause thrombocytopenia

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5
Q

Streptozocin -> Zanosar

A

Nitrosoureas
Used for insulinomas
- mainly in referring practice

ADR

  • can cause tubular necrosis -> so only use with IV fluid diuresis
  • can result in Type I diabetes
  • vomiting common in dogs
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6
Q

Cisplatin: Platinol

A

Platinum-based drugs
MOA
- inhibits DNA synthesis

Used for solid tumours = osteosarcomas, carcinomas, mast cell tumours

Nephrotoxicity is limiting factor to therapy
Vomiting and Diarrhea
DON’T USE IN CATS
- can cause rapidly fatal pulmonary edema

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7
Q

Carboplatin

A

Platinum-based drug
less nephrotoxic than cisplatin
Thrombocytopenia
Can be used in cats

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8
Q

Anti-metabolites -> Cellular enzyme inhibitors

A

Drugs that mess up metabolism w/in the cell

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9
Q

Toceranib -> Palladia

A

Enzyme inhibitor -> tyrosine kinase
- tx of cutaneous mast cell tumors

Anti-tumour and anti-angiogenic activity

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10
Q

Vincristine -> Oncovin

A

Vinca alkaloids
- derived from periwinkle plant

Used in lymphoma protocols

ADR
- tissue necrosis if given perivascular (make 100% sure that catheter is in the vein)
Constipation

Therapy for immune-mediated thrombocytopenia

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11
Q

Doxorubicin -> Adriamycin

A

Anthracine (anti-tumour) antibiotics
Red death
Also for lymphosarcoma, osteosarcoma, mammary carcinomas and other tumours

ADR 
 - if given perivascular = severe tissue necrosis 
 - cardiotoxicity 
 - acute bone marrow suppression 
Less sever ADR 
 - alopecia
 - GI toxicity 
 - hypersensitivity rxn from mast cell degranulation
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12
Q

Glucocorticoids

Chemotherapy

A

Stimulates appetite and attitude

Decreases cachexia from TNS

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13
Q

Glucocorticoids (Immune-mediating)

A

Very generalized immunosuppression
The anti-inflammatory or immunosuppressive effects are dose-dependent

Alters leukocyte migration and function

  • decreases function of monocytes, macrophages, and lymphocytes
  • cell-mediated immunity is decreased most

Prednisone or prednisolone
Dexamethasone
Isuflupredone (Predef 2X)

Start parenteral and then continue PO

  • rule of thumb w/ steroids for immunosuppression => start w/ injections to get more of an immediate effect and then have owners continue PO at home
  • start aggressive then taper
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14
Q

Azathioprine (Imuran)

A

Immunosuppresive
Purine anti-metabolite = interferes w/ DNA synthesis

Oral or injectable
Metabolized in liver to an active and inactive metabolite
- lots of variability bw animals

Variety of immunosuppressive uses in dogs
- lymphocytes more susceptible

Side Effects

  • Myelosuppression
    • especially in cats due to decreased hepatic clearance
  • anemia
  • Pancreatitis and increased liver enzymes
  • rebound hyper-immune response if rapid discontinuation
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15
Q

Chlorambucil (Leukeran)

A

Alkylating agent that cross-links DNA

Similar to cyclophosphamide but less potent/toxic

Use for lymphocytic/plasmacytic infiltrative diseases => IBD, indolent ulcers, pemphigus, atopy

Side Effects
- myelosuppression and vomiting

Expensive to used for cats and small dogs

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16
Q

Cyclosporine (Atopica)

A

Inhibits cytoplasmic enzyme calceurin phsophatase => decreased IL-2 prod
- decreased cytokines = decreased T-cell activation, chemotaxis, antigen presenting cells, mast cell and eosinophil infiltration

Capsules for dogs
Solution for cats
- control of feline allergic dermatitis
- Eosinophilic granuloma/indolent ulcer
- Plasmacytic stomatitis
F highly variable

Topical ophthalmic -> Optimmune

  • keratoconjunctivitis sicca/KCS
  • chronic superficial keratitis/CSK in dogs

Adverse Effects

  • In general pretty safe and effects we see are mild and rare
  • vomiting
  • Gingival hyperplasia
  • Drug interactions => P-gp/CYP substrates
17
Q

2nd line systemic immunosuppressants

A

Sometimes used as adjuncts in IMHA dogs

Leflunomide (Arava)
Mycophenolate Mofetil

18
Q

Apoquel (oclacitinib)

A

Derm-specific immunosuppressive

Stops production of certain cytokines (IL-31)

For control of pruritus associated w/ allergic dermatitis
And control of atopic dermatitis in dogs at least 1 yr

Adverse Effects (rare)

  • Immunosuppression => secondary infection, demodecosis
  • Low incidence of V/D
19
Q

Cytopoint (lokivetMAB)

A

Derm-specific immunosuppressive

Same target compound as Apoquel (i.e. IL-31) just different method
- canine monoclonal antibody against IL-31

Aids in reduction of clinical signs associated w/ atopic dermatitis in dogs

  • reduces pruritus
  • DOESN’T SOLVE UNDERLYING ALLERGY PROBLEM

SC injection and has long duration of effect (>30d)

Can be used concurrently w/ other AD therapy

20
Q

Erythropoietin/EPO/Epoetin

A

Hematologic drug –> RBC stimulation

Used in anemia due to CKD -> bc EPO produced in kidney peritubular cells
- Myelodysplasia (not enough RBC production)

21
Q

Antithrombic Drugs

A

Prevent thrombosis but not so much to cause hemorrhage

Includes anticoagulants, thrombolytics, antiplatelet drugs

22
Q

Heparin

A

Anticoagulant

It’s a GAG that’s negatively charged
Has significant anticoagulant activities

23
Q

Dicoumarol

Warfarin

A

Anticoagulants

Interfere w/ Vit K-dependent coagulation factors

24
Q

Thrombolytics

A

Enhance clot breakdown/fibrinolysis by stim conversion of plasminogen to plasmin

Includes streptokinase and tPA

25
Q

Aspirin

Clopidogrel

A

Affect platelet activation
Not often used for anti-platelet aggregation but can be secondary drug in certain conditions of excess coagulation diseases

Pharmacology (5 decks)

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